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Hepatitis C Viral Infection in Liver Transplantation

Hepatitis C Viral Infection in Liver Transplantation Abstract Objective: To study the outcomes of patients who underwent liver transplantation for the primary diagnosis of chronic active hepatitis secondary to hepatitis C virus (HCV). Design and Setting: Retrospective review within a university medical center. Patients: Seventy-four adult recipients who received 78 orthotopic liver allografts for the primary diagnosis of chronic active hepatitis secondary to HCV between January 1990 and December 1994. Sixty-seven patients (91%) survived more than 2 months and were analyzed further for recurrent HCV infection. Main Outcome Measures: Recurrence of HCV infection, hepatitis, or cirrhosis and survival rates for patients who were undergoing orthotopic liver transplantation for chronic active hepatitis secondary to HCV. Results: Actuarial survival rates for the entire group were 79.3%, 70.9%, and 64.5% at 1, 2, and 3 years, respectively. Four patients (5%) underwent retransplantation with an actuarial survival rate of 14.3% at 1 year (P<.05). Thirty-eight patients (57%) had evidence of posttransplant HCV infection, 31 patients (46%) showed histologic evidence of viral hepatitis, and 11 patients (16%) experienced portal fibrosis or cirrhosis. Seven (33%) of the deaths and all retransplantations were secondary to recurrent HCV infection. There were no significant differences in age, sex, United Network of Organ Sharing status, associated diagnoses, intraoperative packed red blood cell requirements, OKT3 use, or 1-, 2-, and 3-year survival rates in the recurrent vs nonrecurrent HCV infection groups. A higher incidence of posttransplant cirrhosis was observed in patients who were treated with tacrolimus (FK 506) (31.8% vs 8.9%, P<.05). Twenty-one patients (70%) received interferon alfa antiviral therapy with a significant benefit in the liver function test results during therapy (P<.01). Conclusions: Despite recurrence of HCV infection in most patients after transplantation, survival following primary orthotopic liver transplantation for chronic active hepatititis secondary to HCV infection remains favorable, and these patients should continue to be candidates for liver transplantation. In contrast, survival following retransplantation for HCV infection is poor and should be reconsidered. There is an apparent association between the intensity of immunosuppression and recurrent HCV infection and cirrhosis that warrants continued evaluation. Interferon therapy appears to afford benefit to patients in whom recurrent HCV hepatitis develops after transplantation.(Arch Surg. 1996;131:284-291) References 1. Kuo G, Choo Q, Alter HJ, et al. An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis . Science . 1989;244:362-364.Crossref 2. Pereira BJG, Milford EL, Kirkman RL, et al. Transmission of hepatitis C virus by organ transplantation . N Engl J Med . 1991;325:454-460.Crossref 3. Pereira BJG, Milford EL, Kirkman RL, et al. Prevalence of hepatitis C virus RNA in organ donors positive for hepatitis C antibody and in the recipients of their organs . N Engl J Med . 1992;327:910-915.Crossref 4. Poterucha JJ, Rakela J, Lumeng L, Lee CH, Taswell HF. Wiesner RH. Diagnosis of chronic hepatitis C after liver transplantation by the detection of viral sequences with polymerase chain reaction . Hepatology . 1992;15:42-45.Crossref 5. Read AE, Donegan E, Lake J, et al. Hepatitis C in liver transplant recipients . Transplant Proc . 1991;23( (pt 2) ):1504-1505. 6. Cristiano K, Di Bisceglia AM, Hoofnagle JH, Feinstone SM. Hepatitis C viral RNA in serum of patients with chronic non-A, non-B hepatitis: detection by polymerase chain reaction using multiple primer sets . Hepatology . 1991;14:51-55.Crossref 7. Wright TL, Donegan E, Hsu HH. et al. Recurrent and acquired hepatitis C viral Infection in liver transplant recipients . Gastroenterology . 1992;103:317-322. 8. Shah G, Demetris AJ, Gavaler JS, et al. Incidence, prevalence, and clinical course of hepatitis C following liver transplantation . Gastroenterology . 1992;103:323-329. 9. Wright TL. Liver transplantation for chronic hepatitis C viral infection . Gastroenterol Clin North Am . 1993;22:231-240. 10. Mattson L, Weiland O, Glaumann H. Chronic non-A, non-B hepatitis developed after transfusion, illicit self-injections or sporadically . Liver . 1989;9:120-127.Crossref 11. Ferrell LD. Wright TL, Roberts J. Ascher N, Lake J. Hepatitis C viral infection in liver transplant recipients . Hepatology . 1992;16:865-876.Crossref 12. Alter MJ, Purcell RH. Shih JW, et al. Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis . N Engl J Med . 1989;321:1494-1500.Crossref 13. Hsu HH, Wright TL, Tsao SC, et al. Antibody response to hepatitis C virus infection after liver transplantation . Am J Gastroenterol . 1994;89:1169-1174. 14. van der Poel CL, Cuypers HT. Reesink HW. Hepatitis C virus six years on . Lancet . 1994;344:1475-1479.Crossref 15. Donegan E, Wright TL, Kim M, et al. Diagnosis of hepatitis C virus HCV infection in liver transplant recipients . Hepatology . 1992:16:70. 16. Féray C, Gigou M, Samuel D, et al. The course of hepatitis C virus infection after liver transplantation . Hepatology . 1994;20:1137-1143. 17. Lumbreras C, Delgado R, Fuertes A, et al. Clinical significance of hepatitis C virus (HCV) infection in liver transplant recipients: role of serology and HCV RNA detection . Dig Dis Sci . 1994;39:965-969.Crossref 18. Sheiner PA, Schwartz ME, Mor E, et al. Severe or multiple rejection episodes are associated with early recurrence of hepatitis C after orthotopic liver transplantation . Hepatology . 1995:21:30-34.Crossref 19. Wright TL. Hepatitis C virus infection and organ transplantation: review . Prog Liver Dis . 1993;11:215-230. 20. Shiffman ML, Contos MJ, Luketic VA, et al. Biochemical and histologic evaluation of recurrent hepatitis C following orthotopic liver transplantation . Transplantation . 1994;57:526-532.Crossref 21. Konig V, Bauditz J, Lobeck H, et al. Hepatitis C virus reinfection in allografts after orthotopic liver transplantation . Hepatology . 1992;16:1137-1143. 22. Chazouilleres O, Kim M, Combs C, et al. Quantification of hepatitis C virus RNA in liver transplant recipients . Gastroenterology . 1994;106:994-999. 23. Ascher NL, Lake JR, Emond J, Roberts J. Liver transplantation for hepatitis C virus-related cirrhosis . Hepatology . 1994;20( (pt 2) ):24S-27S.Crossref 24. Mueller AR, Platz KP, Bechstein WO, et al. Increased rejection after liver transplantation in FK 506-treated patients is associated with viral hepatitis C disease . Transplant Proc . 1994;26:3637-3639. 25. Davis GL, Balart LA, Schiff ER, et al. Treatment of chronic hepatitis C with recombinant interferon alfa . N Engl J Med . 1989;321:1501-1510.Crossref 26. Wright HI, Gavaler JS, Van Thiel DH. Preliminary experience with alpha-2b-interferon therapy of viral hepatitis in liver allograft recipients . Transplantation . 1992;53:121-124.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Hepatitis C Viral Infection in Liver Transplantation

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1996.01430150062013
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Abstract

Abstract Objective: To study the outcomes of patients who underwent liver transplantation for the primary diagnosis of chronic active hepatitis secondary to hepatitis C virus (HCV). Design and Setting: Retrospective review within a university medical center. Patients: Seventy-four adult recipients who received 78 orthotopic liver allografts for the primary diagnosis of chronic active hepatitis secondary to HCV between January 1990 and December 1994. Sixty-seven patients (91%) survived more than 2 months and were analyzed further for recurrent HCV infection. Main Outcome Measures: Recurrence of HCV infection, hepatitis, or cirrhosis and survival rates for patients who were undergoing orthotopic liver transplantation for chronic active hepatitis secondary to HCV. Results: Actuarial survival rates for the entire group were 79.3%, 70.9%, and 64.5% at 1, 2, and 3 years, respectively. Four patients (5%) underwent retransplantation with an actuarial survival rate of 14.3% at 1 year (P<.05). Thirty-eight patients (57%) had evidence of posttransplant HCV infection, 31 patients (46%) showed histologic evidence of viral hepatitis, and 11 patients (16%) experienced portal fibrosis or cirrhosis. Seven (33%) of the deaths and all retransplantations were secondary to recurrent HCV infection. There were no significant differences in age, sex, United Network of Organ Sharing status, associated diagnoses, intraoperative packed red blood cell requirements, OKT3 use, or 1-, 2-, and 3-year survival rates in the recurrent vs nonrecurrent HCV infection groups. A higher incidence of posttransplant cirrhosis was observed in patients who were treated with tacrolimus (FK 506) (31.8% vs 8.9%, P<.05). Twenty-one patients (70%) received interferon alfa antiviral therapy with a significant benefit in the liver function test results during therapy (P<.01). Conclusions: Despite recurrence of HCV infection in most patients after transplantation, survival following primary orthotopic liver transplantation for chronic active hepatititis secondary to HCV infection remains favorable, and these patients should continue to be candidates for liver transplantation. In contrast, survival following retransplantation for HCV infection is poor and should be reconsidered. There is an apparent association between the intensity of immunosuppression and recurrent HCV infection and cirrhosis that warrants continued evaluation. Interferon therapy appears to afford benefit to patients in whom recurrent HCV hepatitis develops after transplantation.(Arch Surg. 1996;131:284-291) References 1. Kuo G, Choo Q, Alter HJ, et al. An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis . Science . 1989;244:362-364.Crossref 2. Pereira BJG, Milford EL, Kirkman RL, et al. Transmission of hepatitis C virus by organ transplantation . N Engl J Med . 1991;325:454-460.Crossref 3. Pereira BJG, Milford EL, Kirkman RL, et al. Prevalence of hepatitis C virus RNA in organ donors positive for hepatitis C antibody and in the recipients of their organs . N Engl J Med . 1992;327:910-915.Crossref 4. Poterucha JJ, Rakela J, Lumeng L, Lee CH, Taswell HF. Wiesner RH. Diagnosis of chronic hepatitis C after liver transplantation by the detection of viral sequences with polymerase chain reaction . Hepatology . 1992;15:42-45.Crossref 5. Read AE, Donegan E, Lake J, et al. Hepatitis C in liver transplant recipients . Transplant Proc . 1991;23( (pt 2) ):1504-1505. 6. Cristiano K, Di Bisceglia AM, Hoofnagle JH, Feinstone SM. Hepatitis C viral RNA in serum of patients with chronic non-A, non-B hepatitis: detection by polymerase chain reaction using multiple primer sets . Hepatology . 1991;14:51-55.Crossref 7. Wright TL, Donegan E, Hsu HH. et al. Recurrent and acquired hepatitis C viral Infection in liver transplant recipients . Gastroenterology . 1992;103:317-322. 8. Shah G, Demetris AJ, Gavaler JS, et al. Incidence, prevalence, and clinical course of hepatitis C following liver transplantation . Gastroenterology . 1992;103:323-329. 9. Wright TL. Liver transplantation for chronic hepatitis C viral infection . Gastroenterol Clin North Am . 1993;22:231-240. 10. Mattson L, Weiland O, Glaumann H. Chronic non-A, non-B hepatitis developed after transfusion, illicit self-injections or sporadically . Liver . 1989;9:120-127.Crossref 11. Ferrell LD. Wright TL, Roberts J. Ascher N, Lake J. Hepatitis C viral infection in liver transplant recipients . Hepatology . 1992;16:865-876.Crossref 12. Alter MJ, Purcell RH. Shih JW, et al. Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis . N Engl J Med . 1989;321:1494-1500.Crossref 13. Hsu HH, Wright TL, Tsao SC, et al. Antibody response to hepatitis C virus infection after liver transplantation . Am J Gastroenterol . 1994;89:1169-1174. 14. van der Poel CL, Cuypers HT. Reesink HW. Hepatitis C virus six years on . Lancet . 1994;344:1475-1479.Crossref 15. Donegan E, Wright TL, Kim M, et al. Diagnosis of hepatitis C virus HCV infection in liver transplant recipients . Hepatology . 1992:16:70. 16. Féray C, Gigou M, Samuel D, et al. The course of hepatitis C virus infection after liver transplantation . Hepatology . 1994;20:1137-1143. 17. Lumbreras C, Delgado R, Fuertes A, et al. Clinical significance of hepatitis C virus (HCV) infection in liver transplant recipients: role of serology and HCV RNA detection . Dig Dis Sci . 1994;39:965-969.Crossref 18. Sheiner PA, Schwartz ME, Mor E, et al. Severe or multiple rejection episodes are associated with early recurrence of hepatitis C after orthotopic liver transplantation . Hepatology . 1995:21:30-34.Crossref 19. Wright TL. Hepatitis C virus infection and organ transplantation: review . Prog Liver Dis . 1993;11:215-230. 20. Shiffman ML, Contos MJ, Luketic VA, et al. Biochemical and histologic evaluation of recurrent hepatitis C following orthotopic liver transplantation . Transplantation . 1994;57:526-532.Crossref 21. Konig V, Bauditz J, Lobeck H, et al. Hepatitis C virus reinfection in allografts after orthotopic liver transplantation . Hepatology . 1992;16:1137-1143. 22. Chazouilleres O, Kim M, Combs C, et al. Quantification of hepatitis C virus RNA in liver transplant recipients . Gastroenterology . 1994;106:994-999. 23. Ascher NL, Lake JR, Emond J, Roberts J. Liver transplantation for hepatitis C virus-related cirrhosis . Hepatology . 1994;20( (pt 2) ):24S-27S.Crossref 24. Mueller AR, Platz KP, Bechstein WO, et al. Increased rejection after liver transplantation in FK 506-treated patients is associated with viral hepatitis C disease . Transplant Proc . 1994;26:3637-3639. 25. Davis GL, Balart LA, Schiff ER, et al. Treatment of chronic hepatitis C with recombinant interferon alfa . N Engl J Med . 1989;321:1501-1510.Crossref 26. Wright HI, Gavaler JS, Van Thiel DH. Preliminary experience with alpha-2b-interferon therapy of viral hepatitis in liver allograft recipients . Transplantation . 1992;53:121-124.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Mar 1, 1996

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